Provider Demographics
NPI:1093704108
Name:MEDICAL EYE SPECIALISTS PC
Entity Type:Organization
Organization Name:MEDICAL EYE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-587-1245
Mailing Address - Street 1:300 N WILLSON AVE
Mailing Address - Street 2:STE 1003
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3551
Mailing Address - Country:US
Mailing Address - Phone:406-587-1245
Mailing Address - Fax:406-587-1092
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:SUITE 1003
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3578
Practice Address - Country:US
Practice Address - Phone:406-587-1245
Practice Address - Fax:406-587-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS2449OtherRAILROAD MEDICARE
MT0370480001Medicare NSC
MT000008408Medicare PIN